Low intestinal obstruction

Low intestinal obstruction is defined as one occurring in the distal ileum or colon. The symptoms are vomiting, abdominal distension, and failure to pass meconium. 

For practical purposes, the differential diagnosis of low intestinal obstruction in the neonate consists of five conditions. Two conditions involve the distal ileum and include ileal atresia and meconium ileus, and three involve the colon, which are colonic atresia, Hirschsprung s disease, and functional immaturity of the colon that includes meconium plug... 

Ileal atresia is an important cause for low intestinal obstruction. It represents approximately 50% of small bowel atresias and the etiology is similar to that of jejunal atresia. As jejunal atresias, they are believed to result from an intrauterine vascular injury. Approximately 25% have a history of polyhydramnios (Sweeney et al. 2001). 

Nausea is often assumed to be a low level stimulation of the vomiting reflex. However, vomiting occurs without nausea in intestinal obstruction and in space... 

Hypersensitivity to any ingredient nausea, vomiting, or other symptoms of appendicitis fecal impaction intestinal obstruction undiagnosed abdominal pain patients who require a low galactose diet (lactulose). 

Examination showed that her lower abdomen was a little distended and very tender, but there were no other abnormalities. Her blood pressure was low at 102/70 mmHg and her temperature slightly raised at 38.5 °C. A blood sample showed normal haemoglobin and red cell number, but a raised white blood cell count. No intestinal obstruction showed on an X-ray of her abdomen. In view of her symptoms and age, a provisional diagnosis of diverticulitis was made. 

Neonatal Intestinal Obstruction I High Obstruction 2 Low Obstruction 14 Necrotizing Enterocolitis 29 Pneumoperitoneum 34... 

In the newborn period the patient may present with a delay or failure to pass meconium, distension of the abdomen, bilious vomiting or signs of neonatal intestinal obstruction. An AXR will show evidence of low obstruction but will be non-specific however, it may allow assessment of the lower spine and in Hirschsprung s disease a lack of air in the distal colon or rectum may he a sign of congenital agan-glionosis (Fig. 6.9a). 

In clinical chemistry, the variations of the Na concentration level in the extracellular fluid are interpreted as follows [3] (1) The level of Na" is elevated in dehydration (water deficit), central nervous system trauma or disease, and hyperadrenocorticism with hyperaldosteronism or corticosterone of corticosteroid excess. (2) A decrement of the Na level is observed in adrenal insufficiency, in renal insufficiency (especially with inadequate Na intake), in renal tubular acidosis as a physiological response to trauma and bums (Na shifts into cells), in unusual losses via the gastrointestinal tract as in acute or chronic diarrhea or intestinal obstruction or fistula, and in unusual sweating with inadequate sodium replacement. In some patients with edema associated with cardiac or renal disease, seram Na concentration is low, even though total body sodium content is greater than normal water retention (excess antidiuretic hormone, ADH) and abnormal distribution of sodium between intracellular and extracellular fluid contribute to this paradoxical situation. Hyperglycemia occasionally results in a shift of intracellular water to the extracellular... 

Octreotide inhibits intestinal secretion and has dose-related effects on bowel motility. In low doses (50 meg subcutaneously), it stimulates motility, whereas at higher doses (eg, 100-250 meg subcutaneously), it inhibits motility. Octreotide is effective in higher doses for the treatment of diarrhea due to vagotomy or dumping syndrome as well as for diarrhea caused by short bowel syndrome or AIDS. Octreotide has been used in low doses (50 meg subcutaneously) to stimulate small bowel motility in patients with small bowel bacterial overgrowth or intestinal pseudo-obstruction secondary to scleroderma. 

Cholestyramine is indicated as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated low-density lipoprotein [LDL] cholesterol) who do not respond adequately to diet. Similarly, it is indicated for the relief of pruritus associated with partial biliary obstruction. Cholestyramine is not absorbed but binds to bile acids in the intestine, whereupon it is eliminated. To replenish the lost bile acid, cholesterol is then converted to bile acid, and this lowers the level of cholesterol (see Figure 34). Cholestyramine has also been used in the treatment of cholestasis to control the intense pruritis. It reduces the LDL level in 4 to 7 days, and the maximum effect is seen in 14 days. 

The yellowing of the skin known as jaundice can occur if the heme degradation system is overburdened (e.g., from excessive hemolysis), if the liver fails to conjugate bilirubin, or if there is obstruction of the flow of heme breakdown products into the intestinal tract. Bilirubin is toxic, and continued exposure to excessive bilirubin levels can cause brain dam-age.434.439 Bilirubin has a low water solubility and tends to form complexes with various proteins, perhaps partly because it assumes folded conformations raiher than the linear one shown in Fig. 24-24. °... 

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